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ASSESSMENT OF GERD FREQUENCY, SEVERITY AND DURATION: PATTERNS IN ESOPHAGEAL ADENOCARCINOMAS CASES DO NOT DIFFER FROM POPULATION CONTROLS
Olugbenga Okusanya*1, Rajeev Dhupar1, James D. Luketich1, Abraham Apfel2, Marnie Bertolet2, Thomas Vaughan3, Galen E. Switzer4, Katie S. Nason1
1Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; 2Biostatistics, University of Pittsburgh, Pittsburgh, PA; 3Fred Hutchinson Cancer Center, Seattle, WA; 4Medicine, University of Pittsburgh, Pittsburgh, PA
Objective: Population studies report strong associations between gastroesophageal reflux and esophageal adenocarcinoma, prompting endoscopic screening recommendations for patients with long-standing reflux. Lifetime reflux patterns are poorly elucidated, however, limiting screening efficacy. Our study aimed to determine whether reflux symptom duration, severity, and frequency differed between esophageal adenocarcinoma patients and population controls.
Methods: Patients with newly diagnosed esophageal adenocarcinoma were matched (age [+/- 5yrs], race, & sex) to population controls; both gropus completed a structured telephone interview (n=156 pairs). Groups were compared on gastroesophageal reflux symptom presence during their lifetime (in increments by age groupings - <18, 18-35, 36-50, 51-65, >65), duration in years, frequency (never, less than once a month, once a month, once a week, several times a week, daily) and severity (mild, moderate, severe, very severe). Use of anti-reflux medications was also evaluated, including prescription and over-the-counter utilization. Analysis was performed using statistical tests for paired data.
Results: Cases and controls were well-matched for age (median 65 vs 65), sex (85% male in both groups), and race (100% Caucasian). Overall, cases were more likely than controls to report heartburn (78% vs 64%; p=0.015) and acid regurgitation (72% vs 57%; p=0.004) in their lifetime. Among 74 pairs in which both reported heartburn, there were no statistically significant differences in symptom duration (mean 12.9 vs 16.9 years; p=0.083). Symptoms were significantly more frequent for cases between ages 18-35 (p for trend 0.016), with symptoms once a week (16% vs 8%), several times a week (10% versus 8%) or daily (5% versus 3%, respectively). There were no differences in frequency of symptoms in any other time period. Symptoms were most severe between ages 36 & 50 (33% versus 37%) and 51 & 65 (24% versus 27%) and the pattern did not differ between groups (p for trend = 0.273). Symptoms during time period of greatest severity were mild (35% vs 38%) or moderate (36% vs 41%) and did not differ between groups (p for trend 0.547) Cases were as likely as controls (56% versus 51%; p=0.487) to consult their physician about heartburn and to use proton pump inhibitors (54% versus 47%; p=0.522). Frequency, duration and severity were not different among the 66 pairs reporting acid regurgitation.
Conclusions: Though esophageal cancer cases were more likely to report reflux symptoms in their lifetime, symptom duration, severity, and frequency did not differ from controls except during the young adult years, where cases experienced significantly greater frequency but not severity compared to controls. These results highlight the need to take into account additional factors in identifying persons who might benefit from screening endoscopy.
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